The Fidelis Care Blog

The following sections of the Fidelis Care authorization grids have been updated effective May 1, 2022.

The Medicaid, Essential Plan, Medicare, & Metal Level Plan grids have been updated as follows:

• Outpatient and DME Services: The following services require prior authorization:
  • Effective 10/1/2021, Outpatient Therapy, including services rendered in the home:  Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST): Please note, CPT codes 92610 and 92611, do not require prior authorization.

Pharmacy:

• The following code has been added to the Medicaid authorization grid and requires prior authorization:

J9202  goserelin (Zoladex)~

~ authorization is required for NYM/HARP members; it is not required for CHP members

Visit:  Authorization Grids

COVID-19 UPDATE: Please refer to this link:  Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.

The following sections of the Fidelis Care authorization grids have been updated effective May 1, 2022.

The Medicaid, Essential Plan, Medicare, & Metal Level Plan grids have been updated as follows:

• Outpatient and DME Services: The following services require prior authorization:
  • Effective 10/1/2021, Outpatient Therapy, including services rendered in the home:  Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST): Please note, CPT codes 92610 and 92611, do not require prior authorization.

Pharmacy:

• The following code has been added to the Medicaid authorization grid and requires prior authorization:

J9202  goserelin (Zoladex)~

~ authorization is required for NYM/HARP members; it is not required for CHP members

Visit:  Authorization Grids

COVID-19 UPDATE: Please refer to this link:  Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.